CHICAGO – A four-item pregnancy-specific sleep disturbance scale proved valid as a screening tool for sleep-disordered breathing in pregnancy, and was associated with preeclampsia in a study of more than 1,100 women.
After adjustment for potential confounders – including sociodemographics, body mass index, and high blood pressure – a higher score on the short-form pregnancy-specific questionnaire (SF-SPQ) was significantly associated with an increase in the risk of preeclampsia (adjusted risk ratio, 1.54) Alpna Agrawal, Ph.D., of the University of Texas Health Science Center, Houston, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.
"In a clinical setting, the short format and validity of SF-SPQ shown in this study suggests it may be a quick and effective method to screen women at risk for sleep-disordered breathing," Dr. Agrawal wrote.
The SF-SPQ was developed based on data collected from 1,153 pregnant women seen in three outpatient clinics between 2010 and 2013. Sleep patterns were assessed by the Berlin Questionnaire, Epworth Sleepiness Scale, and by questions regarding napping behavior. A confirmatory factor analysis (CFA) was performed to develop a sensitive and specific sleep scale derived from the findings. The scale ultimately included "snoring frequently," "bothersome snoring," "stopped breathing while sleeping," and "falling asleep while driving."
"These items were conceptually related to sleep-disordered breathing during pregnancy, statistically intercorrelated, and/or associated with adverse outcomes. CFA factor loadings were significant and model fit was good," Dr. Agrawal wrote.
In addition to higher score on the SF-SPQ, adjusted relative risks of adverse outcomes were associated with BMI greater than 30 (adjusted relative risk, 1.55), hypertension (adjusted RR, 5.07), and screening positive on the Berlin Questionnaire (adjusted RR, 2.45).
"These data suggest that comorbid conditions such as obesity and hypertension (which are themselves a part of the Berlin Questionnaire) drive association with pregnancy outcomes. However, preeclampsia was independently associated with the SF-SPQ," Dr. Agrawal noted.
Prior studies have demonstrated that sleep-disordered breathing during pregnancy is associated with adverse pregnancy outcomes, but an efficient and efficacious screening tool for sleep disorders has been lacking.
The findings are important, because in the United States, preeclampsia affects up to 6% of pregnancies and is linked with other morbidities such as intrauterine growth restriction, and because studies suggest that the use of continuous positive airway pressure (CPAP) can reduce the risk of preeclampsia in pregnant patients with sleep-disordered breathing.
Additional research is needed to evaluate the efficacy of the SF-SPQ for detecting women at risk, Dr. Agrawal concluded.
Dr. Agrawal reported having no disclosures.